Stent For Life, Egypt A Success Story Hany Ragy MD, FSCAI NHI, - PowerPoint PPT Presentation

Stent For Life, Egypt A Success Story Hany Ragy MD, FSCAI NHI, Cairo, Egypt @hragy

Stent For Life Initiative in Egypt Professor Mohamed Sobhy , MD, FACC, FESC Professor of Cardiology Department, Alexandria University - Egypt Past President of the Egyptian Society of Cardiology Governor of ACC Chapter in Egypt CardioAlex Chairman Chairman of ICC Hospital, Alexandria SFL Egypt Champion

Egyptian Journey in pPCI • 2006 : Workshops,Discussions,cases. • 2007 : We started to share in international track..

Egyptian Journey in pPCI - continued End of 2010 : We finally found our way

Egyptian Situation Egyptian Population 105,000,000 100,000,000 95,000,000 90,000,000 85,000,000 80,000,000 75,000,000 70,000,000 Population 2018 2017 2016 2015 2014 2013 2012 2011

Egyptian Situation 200 180 160 140 120 100 80 60 40 20 0 2012 2013 2014 2015 2016 2017 Expected 2018 Number of cathlabs Number of Cathlabs working 24/7 SSL Pilot centers Government Reimbursement

The start .. • November 2010 • Brain storming Camp • 80 eminent Intervention Cardiologists , MOH representatives , NGOs , Health Insurance , EMS and ..The minister of Health .

(1) Need Registry (2) MOH Ambulance (6) Patient capacity for MOH Funding geographic distribution (B) Gathering Baseline Data MOH (3) Quality of (5) ER plan ambulance MOH ministry of contact Health center for refer (4) Training programs for PPCI & ER MOH MOH physicians

Current situation : patient pathway • Calls cardiologist Patient The platform we working on … • Calls private hospital • Calls physician from private insurance • Only ambulance from specialised • Calls EMS cardiac hospitals have a physician on • DENIAL board • Not properly trained EMS • ECG only on board in new ambulances • No clear unified protocol • Will drive patient to nearest hospitals • If private insurance : will go to private hospital cathlab • Not all are open 24/7 ICU • Lack of awareness of how to treat an AMI patient • Cathlab not prepared Local hospital for AMI patients Home • Logistic obstacles

www.stentforlifeegypt.com

Egypt situation 2011 Reperfusion Therapies 100% 7 10 12 13 14 1 15 15 90% 17 20 21 25 26 26 0 30 7 35 2 36 80% 37 12 39 40 42 44 5 15 48 50 50 31 52 3 70% 8 10 63 40 60% 15 15 35 50% 55 35 28 92 86 26 30 40% 44 81 81 75 75 72 25 33 70 66 64 30% 59 41 45 49 45 45 29 20% 35 33 30 30 28 24 10% 23 19 19 9 8 5 0% CZ SLO DE CH NO DK PL HR SE HU BE IL IT FIN AT FR SK ES LAT UK BG PO SRB GR TR RO P-PCI Thrombolysis No reperfusion P.Widimsky et al. November 19, 2009. Reperfusion therapy for ST elevation acute myocardial infarction in Europe: description of the current situation in 30 countries. Eur. Heart.J.doi:10.1093/eurheartj/ehp492 Egypt 2011

Reperfusion Therapies Proposed Egypt situation 2015 100% 7 10 12 13 14 1 15 15 90% 17 20 21 25 26 26 0 30 7 35 2 36 80% 37 12 39 40 42 44 5 15 48 50 50 31 52 3 70% 8 10 63 40 60% 15 15 35 50% 55 35 28 92 86 26 30 40% 44 81 81 75 75 72 25 33 70 66 64 30% 59 41 45 49 45 45 29 20% 35 33 30 30 28 24 10% 23 19 19 9 8 5 0% CZ SLO DE CH NO DK PL HR SE HU BE IL IT FIN AT FR SK ES LAT UK BG PO SRB GR TR RO P-PCI Thrombolysis No reperfusion Egypt Egypt 2015 2011 P.Widimsky et al. November 19, 2009. Reperfusion therapy for ST elevation acute myocardial infarction in Europe: description of the current situation in 30 countries. Eur. Heart.J.doi:10.1093/eurheartj/ehp492

Mapping situation 2018

N.B: the upcoming slides are from dr. Moheb Wadie (Mansoura University) ppt in ESC 2018

Life Science Journal 2017;14(3)

Method: Patients: Enrolled 886 ACS patients on 1/6/2011 and closed for statistical analysis on 30/12/2012. All patients signed the hospital standard consent form which allows data collection for study and statistical purposes. Life Science Journal 2017;14(3)

In hospital management • Thrombolytic therapy was used in 264 out of 482 STEMI patients (54.7%) • Streptokinase in 260 patients t-PA was used in 4 patients; 1 out of 404 NSTEMI received Streptokinase. Life Science Journal 2017;14(3)

Discussion: High Use of Thrombolysis • PPCI was used in 37% of STEMI patients while thrombolytic, namely streptokinase were used in 55.6%. • In spite of 24/7 Cath labs and full involvement in stent for life program , less than 40% of STEMI patients coming to NHI undergo PPCI. • IV thrombolysis remains the strategy used in the majority of STEMI patients ; this needs to be addressed. Life Science Journal 2017;14(3)

Identified Unmet needs 1. Teach patients about heart attacks and importance of time. Patients 2. Encourage them to call the emrgency if symptoms were felt 3. Special patient awareness campagins around the pilot centers to monitor the effect of the campagins. 1. EMS team awareness for the diagnosis of MI. E M S 2. To implement all needs for MOH and project coordination. 3. Transporting the data from the car to the hospital. 1. Physician education. Hospitals 2. MOH support. 3. Cath lab equipments and needs including physicians and nurses and techs. 1. Mortality rate in the registry. Registry 2. Need to increase centers in registry phases.

Conclusion • SFL now SSL Egypt was a successful first step in the right direction. • In 2018 the Egyptian MOH formed a National Heart Attack committee mainly formed from the Original SFL members aiming at National level management of Acute Coronary Syndromes.

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